Patient Safety in Anticoagulation: Implementing Safety-II and FRAM in the Medical Curriculum

Medication safety is a cornerstone of patient care, yet traditional error-focused approaches often limit learning opportunities in healthcare. While Safety-I focuses on identifying the root cause of the problem, Safety-II adds the dimension of adaptability and resilience of health care professionals in complex environments. This paper describes an innovative educational intervention aimed at integrating Safety-II, the Functional Resonance Analysis Method (FRAM) and anticoagulation management into an existing medication safety course within the Erasmus University medical curriculum. The course, designed for master's-level medical students, uses Safety-II to analyze everyday clinical successes and to deepen understanding of anticoagulation processes in perioperative care. Students engage with clinical cases, create FRAM models, and reflect on their experiences during clerkships, which enhances their ability to recognize system strengths and adapt to complex situations. Teaching strategies such as 'flipped classroom' and 'just-in-time teaching' were incorporated, aligned with the medical curriculum, and enhanced active learning. Early implementation cycles led to iterative refinement of the course materials, informed by student and stakeholder feedback, as well as learning analytics. The course was successfully integrated into the medical curriculum, and our vision has since extended beyond the next generation of medical doctors. The Safety-II course has also been implemented into our cross-disciplinary education for healthcare professionals in specialist training. By integrating Safety-II thinking into various healthcare disciplines, we strive to contribute to a culture of safer, more resilient care, ensuring that adaptability and continuous learning are prioritized in all aspects of patient safety.